“Electrosurgery” is the application of a high-frequency electric current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue. Electrosurgery includes the ability to make precise cuts with limited blood loss. In electrosurgical procedures, tissue is heated by an electric current
Electrosurgery is performed using an electrosurgical generator, also referred to as a “power supply” or “waveform generator” and a hand piece including one or several electrodes, sometimes referred to as an “RF Knife” or a “Bovie,” after the inventor.
“Electrocauterization” is a type of electrosurgery and includes the process of destroying tissue using heat conduction from a metal probe heated by electric current. The procedure is also used to stop bleeding from small vessels (larger vessels being ligated) or for cutting through soft tissue.
Electrosurgery and electrocauterization techniques are used in the treatment of cancers via electrodesiccation and curettage. Electrosurgery and electrocauterization techniques produce surgical smoke.
“Surgical smoke” generated from electrosurgery and electrocauterization techniques include carbonized tissue, blood, and virus aerosols. In addition, surgical smoke includes gases such as benzene, toluene, formaldehyde, and polycyclic aromatic hydrocarbons that are known carcinogens. These gases also create an “acrid smell” in an operating room.
Another danger from surgical smoke comes from the particle content of the smoke. Particulate smoke posses serious health risks to surgical teams and is similar to second hand smoke from cigarettes.
Another danger from surgical smoke is the transmission of diseases. The AIDS epidemic has focused attention on the routes by which HIV virus may be transmitted. One potential exposure route is inhalation of blood-containing “aerosols” infected with the virus in the operating room. The potential hazard of blood aerosol generated by electrosurgery is from surgical tools capable of generating a wide distribution of particle sizes produced blood-containing particles in the respirable range. Surgical masks typically do not provide adequate respiratory protection against these aerosols produced in surgical smoke.
A “retractor” is a surgical instrument that is used to hold back underlying organs and tissues, so that body parts under the incision may be accessed. It is also used to separate the edges of a surgical incision or wound. Surgical retractors are available in many sizes, shapes, and styles. Surgical retractors are used in different surgical procedures. Retractors are used during operations to help doctors by moving tissue and organs away from the area upon which the surgery is to be performed.
Surgical retractors are very important because they determine the exposure of the operative field. A surgeon needs an exposure best as possible while inflicting a minimum of trauma to the surrounding tissue. The handles of the retractor may be hook shaped, notched, or ring shaped to give the holder a firm grip without tiring. The blades of the retractors are at a right angle to the shaft. The blades can be smooth, raked, or hooked.
Surgical retractors are non-hollow components made from materials that are sterilizable and autoclavable so they may be reused for multiple, successive surgical procedures. A common material used in the making of retractors is stainless steel. Stainless steel is preferred because of its strength and its ability to be sterilized.
However, there are several drawbacks of stainless steel retractors. Stainless steel instruments are expensive to purchase and time consuming to maintain. They become very slippery when they come into contact with blood and other body fluids which can lead to tissue damage during operation. Moreover, stainless steel is also thermally highly conductive which also results in tissue injury as it quickly absorbs heat from the tissue with which it comes in contact. Another disadvantage is that they have reflective surfaces which produce glare under the high level illumination which is very common during surgical procedures.
Generally, there are two types of retractors, self-retaining and hand-held. “Self-retaining” retractors do not need an assistant to hold them in place (e.g., a rib spreader, etc.). “Hand-held” retractors require an assistant to hold them. A hand-held retractor is held by its handle properly so as to produce maximum exposure of the surgical area, maximum leverage, and steady retraction.
During breast surgery and other soft tissue surgery a surgeon has to have fraction on the tissue edge being dissected. Tissue retractors hold tissue flaps away from the treatment site. This provide better visibility, reach and undisturbed working. However, when retractors known in the art used on breast tissues and other soft tissues, such tissues are likely to bleed, tear or rip when retracted.
“Suction” is the flow of a fluid into a partial vacuum, or region of low pressure. The pressure gradient between this region and the ambient pressure will propel matter toward the low pressure area. Typically during most surgeries, a drainage tube is inserted into the wound and attached to a suction device such as an external suction pump to remove subcutaneous fluid, blood and tissue.
There are several problems associated with suction tube devices. The heads on suction tubes often get clogged when larger pieces of tissue are sucked into the device. Suction tubes and devices are very difficult to keep clean and sanitary. They typically require cleaning with brushes and other instruments. They also must be sterilizable and autoclavable. Suction devices are very noisy, especially when multiple suction devices are used. Multiple suction devices contribute to noise pollution in an operating room.
During surgery on soft tissues a surgeon would typically use an electrosurgery device for cutting or dissecting, one or more retractors and one or more suction devices. The surgeon is typically assisted by one or more assistants (e.g., other surgeons, nurses, medical technicians, etc.)
The surgeon has to have fraction on the tissue edge being dissected. At the same time the surgeon is cutting usually with an electrosurgery device that produces a surgical smoke plume that requires a separate suction device held in the wound to evacuate the smoke. Another suction device is used to remove blood, fluids and tissue pieces.
When a wound is narrow or under a flap of tissue (e.g., near a breast nipple) it is very awkward for an assistant to hold a retractor, a separate suction device that effectively evacuates the smoke, and another for blood and irrigating fluids that does not get in the surgeon's line of site.
In a deeper wound it can be difficult for the surgeon to get fraction on the tissue due to the size of the surgeon's hands, the slippery surface of gloves on the one or more retractors or the bulk of sponges that are used to gain a friction hold on the surface of a slippery tissue.
Thus, it is desirable to solve some of the many problems associated with medical instruments used for surgery on soft tissues and other types of human tissues.